The infant, carried by her father, had been vomiting for several days. The patient’s history was consistent with pyloric stenosis, but there were still other differential diagnoses to consider. The surgeon caring for the patient was trained in Morocco and France. He was an excellent physician who returned to his community in the small coastal country of The Gambia in West Africa. The physician needed diagnostic ultrasound to confirm or refute the presumed diagnosis. He was plagued by indecision at the prospect of performing unnecessary surgery on the infant. The patient had traveled at great cost and distance to arrive at the only tertiary care center in the country. Her family needed help and if they could not find it here, they were out of options.
At the invitation of the surgeon, I was taking the entire attending physician group from every specialty available through a point-of-care ultrasound (POCUS) course. The course was tailor-made for surgeons, despite having representatives present from internal medicine and pediatrics. It was reasoned that the largest immediate gains would be from trauma care, ultrasound-guided procedures, and confirmation of surgical diagnoses and complications. The amount of blunt trauma and blind procedures including liver biopsies was staggering.
Each day focused on problem-based and group learning, with gamification and competition built it. The goal was to keep the learners engaged and follow up with deliberate practice every afternoon. The surgeon would bring patients from the hospital who required diagnostics, which were unavailable until now. Patients made the trek up 2 flights of stairs, where we were teaching in the only air-conditioned space. Conditions that would be identified early in high-resource regions are often elusive without the necessary diagnostics. With POCUS, we identified patients with heart failure, pneumonia, bowel obstructions, appendicitis, and complications of pregnancy. We also identified conditions that are less readily seen in high-resource health systems such as rheumatic heart disease and hepatic abscesses.
Each day focused on problem-based and group learning, with gamification and competition built it. The goal was to keep the learners engaged and follow up with deliberate practice every afternoon. The surgeon would bring patients from the hospital who required diagnostics, which were unavailable until now. Patients made the trek up 2 flights of stairs, where we were teaching in the only air-conditioned space. Conditions that would be identified early in high-resource regions are often elusive without the necessary diagnostics. With POCUS, we identified patients with heart failure, pneumonia, bowel obstructions, appendicitis, and complications of pregnancy. We also identified conditions that are less readily seen in high-resource health systems such as rheumatic heart disease and hepatic abscesses.
The surgeon confirmed the diagnosis of pyloric stenosis during our POCUS course. He took his patient to the operating theater with confidence and she did well postoperatively. Ultrasound continues to make a lasting impact in The Gambia. Together, we are building a sustainable program that will incorporate POCUS into all graduate medical education. POCUS impacts care wherever it is used by trained professionals, but in my experience, it is the single most important diagnostic tool in low-resource health systems.
Michael Schick, DO, MA, MIH, FACEP, is an Assistant Professor of Emergency Medicine and Director of International Ultrasound at UC Davis Medical Center.
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